Prenatal alcohol exposure has long been linked to deficits in neurodevelopmental, growth, and systemic functions in infants under the rubric of fetal alcohol spectrum disorders (FASD), with fetal alcohol syndrome at the most severe end of the spectrum. Yet, increasing epidemiologic, physiologic, and pathologic data suggest potential relationships between prenatal alcohol exposure and mortality, including the sudden infant death syndrome (SIDS) and stillbirth. These mortality data in conjunction with the morbidity data underscore the enormous personal and societal burden of maternal drinking during pregnancy, and the urgent need for more effective intervention strategies. The mission of the PASS Network is to perform community-linked studies to determine the role of prenatal alcohol exposure in the risk for SIDS and adverse pregnancy outcomes, especially stillbirth and FASD. This application proposes the completion of enrollment and follow- up of study participants and the performance of data analysis in Phase II of the PASS Network by the Northern Plains Comprehensive Clinical Site (NPCCS). To carry out the mission of the PASS Network, a highly skilled interdisciplinary team has been assembled at the NPCCS that has been working successfully together throughout Phase II. A community-based infrastructure serves as the foundation for the NPCCS that incorporates hospitals, prenatal clinics, pediatric clinics, medical examiner systems, pathology departments, social service agencies, tribal colleges and community review boards. In addition, the NPCCS is responsible for the design and analysis of the FASD case determinations through analysis of facial dysmorphology. The NPCCS conducts all of these activities within a management structure designed to optimize active recruitment and collection of high quality data with care and compassion for the participants and communities it serves. PUBLIC HEALTH RELEVANCE: The potential impact of the Northern Plains CCS is to develop strategies to improve the care of mothers and their children in populations in which prenatal alcohol exposure is a significant public health problem, as delineated in the common section above.